Chronic kidney disease (CKD) represents a growing public health challenge, particularly in low- and middle-income countries, where delayed diagnosis and limited access to early screening contribute to disease progression and increased healthcare burden. Community pharmacies, as accessible primary care points, offer significant potential for early detection and prevention of CKD. To develop, implement, and evaluate a pharmacy-led model for screening, prevention, and delay of CKD progression among high-risk populations in community pharmacy settings under the Universal Health Coverage system in Thailand. This study used an action research design to develop and refine a pharmacist-led CKD care model for community pharmacy settings. Each cycle comprised planning, action, observation, and reflection. Cycle 1 focused on contextual assessment, stakeholder engagement, and initial model development. Cycle 2 involved pilot implementation and qualitative evaluation to identify barriers, facilitators, and required modifications. Cycle 3 incorporated these findings to refine and finalize the care model, followed by implementation in 17 community pharmacies across four provinces. The refined model was implemented among 1,000 adults at high risk of CKD, with assessments at baseline, 3 months, and 6 months. Qualitative data were analyzed thematically, and predefined participant-level outcomes included CKD-related knowledge, lifestyle modification, self-management, kidney function, and medication-related problems. Across the three cycles, iterative qualitative findings informed progressive refinement of the service workflow, data-collection tools, digital support, and referral processes. The final model comprised CKD risk screening, pharmacist-led risk communication and self-management support, medication therapy management, referral and care coordination, and digitally supported longitudinal follow-up. Among 1,000 high-risk participants, the proportion with 205 participants, a positive Microalbuminuria Rapid Test (MRT) result decreased from 20.5
The National Cancer Institute supports the Evidence-Based Cancer Control Programs website as a strategy for disseminating effective interventions to professionals who can use them in practice, including 79 tested in clinical settings such as primary care.
Metabolic syndrome (MetS) is a cluster of risk factors including dyslipidemia, elevated glucose and triglycerides, high blood pressure, and excess abdominal fat that significantly increase the likelihood of developing cardiovascular disease (CVD) and diabetes (DM). MetS is clinically important as it typically precedes DM and CVD by several years. Fortunately, progression can often be delayed or prevented through dietary changes and regular physical activity. This trial evaluated the effectiveness of the Canadian Health Advanced by Nutrition and Grade Exercise (CHANGE) Protocol, a personalized, evidence-based diet and exercise intervention, in reversing MetS in adult patients within typical Alberta primary care settings. A cluster randomized controlled trial (cRCT) was conducted from June 2016 to January 2023. A total of 750 participants with MetS across 16 primary care sites were enrolled and 674 participants were randomized by site into either the intervention group (CHANGE Protocol) or control group (usual care). Blinding was not possible due to the nature of the intervention. The primary outcome was MetS reversal, defined as no longer meeting at least 3 of the 5 diagnostic criteria, measured at 12 months. Eight sites (n = 320 patients) were randomized to the intervention, and eight sites (n = 354 patients) to the control group. All five MetS criteria were assessed before and after the intervention. A logistic regression model evaluated the impact of age, gender, group assignment, and baseline MetS severity on the likelihood of MetS reversal. Results showed that patients completing the intervention were four times more likely to reverse MetS than those in the control group. Additionally, participants meeting only three MetS criteria at baseline were nearly 20 times more likely to reverse the condition compared to those meeting more criteria. The CHANGE Protocol was associated with higher rates of MetS reversal than usual care, highlighting the potential value of early lifestyle intervention. This protocol offers a potential foundation for a broader “Metabolic Rehabilitation” approach, similar to established cardiac rehabilitation programs. ClinicalTrials.gov Identifier: NCT02893163; Registered 2016-09-08.
Diabetes distress (DD), emotional burden of stress, fear, and guilt related to managing diabetes, is linked to poor glycemic control and disproportionately affects vulnerable populations. Although the American Diabetes Association and European Association for the Study of Diabetes recommend routine screening and intervention for DD, few health systems have implemented systematic screening and follow-up, and no studies have evaluated the impact of implementing DD screening and treatment workflows in real-world primary care. ARISE (Achieving Routine Intervention and Screening for Emotional health) is a training and technical assistance program designed to support multidisciplinary teams at community health centers (CHCs) in implementing DD screening and intervention for adults with type 2 diabetes (T2DM), based on the 7 A’s model (Aware, Ask, Assess, Advise, Assist, Assign, Arrange). This is a pragmatic, type 1 hybrid effectiveness-implementation cluster randomized trial in which 12 CHCs in the Midwest will be randomized 2:1 to ARISE (n=8) or Enhanced Usual Care (n=4). Eligible patients are aged ≥ 18 with T2DM and hemoglobin A1c (HbA1c) >8
Empowerment of health providers is widely recognized as a critical factor in enhancing healthcare quality and outcomes. If the capabilities of health providers are not sufficient to the demands of their profession, resulting in reduced motivation, creativity, productivity, organizational dedication, job satisfaction, and increased burnout. Therefore, it is important to be aware of the challenges of empowering health providers. The aim of the present study was to investigate challenges related to health provider’s empowerment working in the urban primary health service center in shiraz, Iran. This was a qualitative study using conventional content analysis approach. The participants were selected by purposive sampling method considering maximal variation. fourteen health providers, two supervisor and two family physicians employed in the primary health service center were recruited until data saturation was reached. Data were collected from April to September 2023 through individual in-depth semi-structured interviews, focus groups, unstructured observations and field notes. Findings were analyzed using a conventional method and MAXQDA 2020. All health providers were women. The average age of participants was 32.87 ± 8.85 years, with an age range of 24–42 years. According to data analysis, 3 main categories including “Inadequacy of health providers training process”, “inefficient management of organization resources” and “weakness in professional performance “with 11 sub categories were developed. This research offered more profound insights into health providers’ challenges to empowerment at the primary health service center. We recommend that health policymakers prioritize the development and implementation of continuous, up-to-date training programs tailored specifically to the evolving roles of primary health providers. Not applicable.
